Decoding Calcium Levels in AKI Cases

A 3-year-old castrated male domestic shorthaired cat was presented to the emergency service for evaluation of acute severe lethargy, anorexia and vomiting. He has been strictly outdoors and was previously in good health. His last annual examination and blood work were performed 2 weeks ago, and they were within normal limits. 

Today, his physical examination showed a body temperature of 97F (36.1C), heart rate of 140 beats per minute, respiratory rate of 44 breaths per minute, stuporous mentation, poor femoral pulses, pale pink mucous membranes, unkempt haircoat and dehydration of at least 7-8%. An ECG, venous blood gas, and thoracic/abdominal point-of-care ultrasound (POCUS) were performed during the primary survey as the intravenous catheter was being placed. 

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LRS vs Citrate: Friend or Foe?

Imagine having a patient who needs simultaneous administration of a citrated blood product and Lactated Ringer’s solution (LRS), but there is only one available peripheral catheter.

Can you administer citrated donor blood or plasma and LRS at the same time?

Conventionally, this practice is discouraged because LRS is a calcium-containing fluid that may be incompatible with citrate due to the risks of calcium chelation and clot formation. Once LRS exceeds the chelating capabilities of the citrate in the stored blood that may result in clot formation, which makes perfect sense. However, as we all know, theory and practice are not the same in clinical medicine. Therefore, let’s explore the evidence to answer this very practical question.

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